Appropriate cardiopulmonary resuscitation duration and predictors of return of spontaneous circulation in traumatic cardiac arrest

Abstract

Purpose Current evidence regarding appropriate durations of cardiopulmonary resuscitation (CPR) and life-saving procedures during traumatic cardiac arrest (TCA) remains debatable. Accordingly, we aimed to identify factors associated with the return of spontaneous circulation (ROSC) and appropriate CPR durations to achieve ROSC in patients with TCA. Methods We conducted a retrospective observational study using a single-centre trauma registry of adult patients with TCA between January 2021 and December 2023. Univariate analysis was conducted to identify differences in baseline and outcome variables between ROSC and no-ROSC groups, while multivariable logistic regression analysis identified factors independently associated with ROSC. We determined appropriate cutoffs for pre-hospital and total CPR duration for ROSC, i.e., CPR durations with maximum sensitivity and specificity for ROSC. Results Of the 422 patients with TCA included, 250 were eligible for analysis. ROSC occurred in 22.4% (n = 56) of patients, while trauma bay/emergency department and in-hospital mortalities occurred in 80.8% (n = 202) and 97.2% (n = 243), respectively. ROSC-related factors included alert mental status in the field, as indicated by a verbal response (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.01–1.12; p = 0.06), pain response (OR, 0.03; 95% CI, 0.01–0.43; p = 0.009), and unresponsive (OR, 0.04; 95% CI, 0.01–0.44; p = 0.009), as well as non-asystolic initial rhythms, including pulseless electrical activity (OR, 4.26; 95% CI, 1.92–9.46; p < 0.001), shockable rhythm (OR, 14.26; 95% CI, 1.44–141.54; p = 0.023), pre-hospital CPR duration (OR, 0.90; 95% CI, 0.85–0.95), and total CPR duration (OR, 0.88; 95% CI, 0.84–0.92; p < 0.001). Upper limits of pre-hospital and total CPR durations for achieving a probability of ROSC < 1% were 23 and 30 min, respectively, while those for a cumulative portion of ROSC > 99% were 27 and 38 min, respectively. Conclusions CPR duration is independently and inversely associated with ROSC. To achieve ROSC, crucial time thresholds for pre-hospital and total CPR durations are 23–27 and 30–38 min, respectively. An alert mental status in the field and a non-asystolic initial cardiac rhythm are positive predictors of ROSC.